Wee Wheezers Asthma Education Program
Implemented in Darnell Army Community Hospital, Ft. Hood, Texas by MAS Consultants Inc., P.O. Box 5130 Aiken, South Carolina 29804.
Wee Wheezers Asthma Education Program: Program Modifications
The DACH-Air Wee Wheezers adheres fairly closely to the technical content of the copyrighted instruction. Changes related to the number of sessions conducted, the ages of children permitted to attend, and use of separate parent-child sessions rather than the combined parent-child sessions have been carried out as well as the elimination of some of the planned group discussions. These changes were made to eliminate group activities that did not produce the desired results when implemented with military families and to improve attendance, where high no-show rates resulted from multiple sessions as outlined in the original instructor’s guide.
Content Elimination or Significant Changes
DACH-Air experienced difficulty retaining high attendance for multiple asthma education sessions that went beyond two class periods. The program was altered to eliminate nonessential information and multiple start up and shut down activities to keep Wee Wheezers to two somewhat longer sessions and retain participants who otherwise would not return.
Because of anxieties related to group sharing of reactions and feelings about how their child’s asthma affects the parents in the class, video segment 2 was eliminated from Session 1. DACH-Air eliminated the discussion of participant’s feelings about their children’s chronic health problem from Session 3.
Within civilian populations, discussions of parents’ feelings about dealing with an asthma crisis or having a child with a chronic disease are routinely used to bring those feelings to mind, acknowledge how frightening and confusing such a crisis can be, and use the possibility of preventing such episodes as a means of motivating parents to make the requisite change. Although useful in this setting, it should not be concluded that segments of the Wee Wheezers program addressing feelings ought to be eliminated or scaled back just because this replicated program has done so.
Because of two factors, DACH-Air decided to eliminate two group discussions about parents’ feelings. First, the rank structure within the military may result in reluctance to express feelings, and the asthma classes comprised parents in a wide range of ranks. Second, stoicism exists among the military as demonstrated by failure to report broken bones suffered during long marches or the inability to talk about events witnessed in war zones. As a compensatory measure, parents are given a copy of the videotape to view at home and receive the handouts on feelings about having children with asthma. Feelings about asthma are fully addressed in the sessions for the children, for whom these barriers are not generally an issue.
DACH-Air reduced the amount of time spent on learning to communicate about asthma with teachers, child-care workers, physicians, and family (addressed in Session 4) and on the review and discussion of the asthma action plan.
This content change is practical for the following reasons. 1) The DACH physicians are required to develop an asthma action plan for new patients, at which time they go over the entire form, or review or update the plan, with the patient at each subsequent office visit. The Medical Record-Supplemental Medical Data form, DA-4700, used to record this action, also requires the physician to teach or correct peak flow meter and spacer use. 2) Each DACH clinic has designated nurses trained to provide instruction on the use of the asthma action plan. Patients are encouraged to call their clinic asthma nurse or the DACH-Air coordinator (a registered nurse) if they have a question about the use of the plan. 3) Printed materials for parents and children explain the use of the plan. In addition, the action plan is included with the documented discharge instructions for asthma admissions and emergency department visits.
In many situations in which Wee Wheezers will be implemented, asthma educators will have to educate the parents about the asthma action plan, then encourage them to take the action plan form to their doctor and ask him/her to write out a plan. Wee Wheezers was developed on the assumption that most patients would receive asthma care that is not as well organized as DACH’s is in this respect. Users of the Wee Wheezers program should include the asthma action plan instruction in the curriculum as designed unless justification is identified for not doing so.
Other Course Changes
The two children’s sessions were designed initially for 45 minutes each to be delivered at the beginning of adult sessions 3 and 4 with the parents hearing the same information as their children. DACH-Air offers two 90-minute sessions for children conducted separately but delivered at the same time as the two adult sessions. The intended audience for this education is children ages 5-6 years. At Ft. Hood, Wee Wheezers is not confined to younger children, but is open to all children aged 5-12 years. Because the children’s sessions are team taught, age appropriate instruction and activities can be tailored for the younger and older children.